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Committees : Surrey Medicines Commissioners Group

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Committee Recommendations (50)

05 Feb 20

Community Pharmacy Surrey & Sussex (CPSS) have produced a briefing to explain the changes to the pharmacy home delivery services - see briefing paper below

Additional information relating to community pharmacy services across Surrey and Sussex can be found on the CPSS website

https://communitypharmacyss.co.uk/

 

11 Sep 19

The palliative care drug access scheme, provided by community pharmacy, has been reviewed.
The MCG and the Primary Care Commissioining Committee have approved the information document (below) and the associated service specification that is available from your local CCG

For a list of your local Community Pharmacies who are providing this service see the document below

04 Sep 19

Practices should have a system in place to ensure that they receive, disseminate and act upon medicines safety alerts in a timely manner.

Practices will need to evidence their actions in relation to relevant safety alerts for the purposes of CQC compliance.

See link to CQC for further information:

https://www.cqc.org.uk/guidance-providers/gps/nigels-surgery-91-patient-safety-alerts

A locally produced list of recent safety alerts has been provided below that practices may wish to use as a "checklist" to assist with their record keeping and awareness. The list will be updated regularly and circulated with the MMM! Newsletter from the Medicines Management Team

06 Mar 19

From 1st April 2019 both pregabalin and gabapentin will be classified as a schedule 3 Controlled Drug. As such, the arrangements through which patients obtain these medicines will change.
The Surrey Medicines Commissioners Group have developed a patient template letter for local adaption - see below.

In addition, NHSE have produced a patient hand-out that is also available below

06 Mar 19

From 1st April 2019 both pregabalin and gabapentin will be classified as a schedule 3 Controlled Drug. As such, the arrangements through which patients obtain these medicines will change.
The Surrey Medicines Commissioners Group have developed a patient template letter for local adaption - see below.

In addition, NHSE have produced a patient hand-out that is also available below

06 Feb 19

PGDs for national immunisation and vaccination programmes which are commissioned by NHS England can be found on the NHSE website for Kent, Surrey & Sussex:

NHS England — South East » South East Patient Group Direction downloads

NHS England are responsible for the production and on-going maintenance of these PGDs.
Queries in relation to PGD content and availability should be directed to the Screening & Immunisation Team: england.surreysussexsit@nhs.net
A further "Immunisations and Vaccination Queries Guide" is also provided below. This guide signposts to a number of useful contacts for queries.

Vaccine / immunisation information is available in the Green Book (link below)

The majority of vaccinations / immunisations for the National Immunisation Programmes are available free of charge via ImmForm. Reimbursement for vaccines obtained in this manner must not be claimed via FP34 or FP10. If in doubt please refer to our Vaccine Claim / Payment Guide for Practices - available below.

07 Nov 18

The MCG acknowledged a recommendation from the Medicines Optimisation in Care Homes (MOCH) group to adopt a range of Care Home resources that were developed by PrescQIPP.

The resources will be reviewed and updated in accordance with the review timescales of PrescQIPP.

These resources can be found below.

05 Sep 18

The Surrey Medicines Commissioners Group agreed that the Surrey Heartlands Managing Diabetes in Care Homes resource was appropriate for local adoption.

See CCG specific documents below

04 Jul 18
UKMI have published a resource aimed at highlighting the precautions to consider when there is a need to switch a patients medicines from one oral form to another.

e.g. liquid to tablets / capsules and vice versa

Whilst this resource provides some useful advice, the MCG concluded that in most instances it would be appropriate for the prescriber to contact their pharmacist for advice
06 Jun 18

In March 2018 NHS England issued guidance on conditions for which over the counter (OTC) medicines should not routinely be prescribed. The MCG supports the principles and recommendations within the guidance but acknowledges the potential conflict with the obligations of the GMS contract that states "a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the Contract".

Prescribers should consider their professional obligations and be mindful of the exceptions identified for each of the conditions as set out in the NHSE guidance below and also of the NHSE Medical Director’s letter issued in January 2019 which may assist in clarifying any concerns about prescribing responsibility and contractual obligations.

See below for:

  • the NHSE list of treatments included within the guidance and the general exceptions
  • the NHSE Medical Director’s letter to practices
  • OTC position statement from the Surrey Medicines Commissioners Group

For further information, a list of treatments included within the guidance and the general exceptions please refer to the documents below

02 May 18

Traffic Light Prescribing Decision Support Tool (document below) - approved by the MCG in May 2018

The aim of this tool is support prescribing decisions where a local Traffic Light status is in conflict with the status from a requesting organisation who is not represented at PCN e.g. tertiary centre

04 Apr 18
The Medicines Commissioners Group agreed to extend the review date for the Unlicensed Medicines Guide - below

The review date has been extended to Sep 2018
07 Mar 18

It is recommended that tramadol modified release preparations are prescribed by BRAND - see UKMI Branded Prescribing Recommendations document below. The locally preferred brand for modified-release, TWICE DAILY dosing is Marol® Marol® is available across all of the twice-daily dose ranges, already represents the most commonly prescribed tramadol brand locally and nationally and remains one of the most cost-effective tramadol MR choices. Patients currently receiving generically written prescriptions should be reviewed with a view to change the prescribing to a cost-effective brand.

07 Mar 18

 

It is recommended that buprenorphine patches are prescribed by BRAND - see UKMI Branded Prescribing Recommendations document. The locally preferred brand for buprenorphine 7-day patches is Butec® Butec® is available across all of the dose ranges, already represents the most commonly prescribed brand nationally (>50%), and is considerably less costly than the originator brand BuTrans. Patients currently receiving generically written prescriptions should be reviewed with a view to change the prescribing to a cost-effective brand.

01 Nov 17

Patient Specific Directions (PSDs) are often used to enable non-medical practitioners (practice nurses, health care assistants) to administer specific medicines for specific conditions. A PSD tempate for EMIS system users has been developed by a local GP practice to improve the consistency and content of their Denosumab PSDs. This PSD template (among others) is available from your local Medicines Management Team should your practice wish to adopt / adapt it. Please contact your local Medicines Management Team for assistance

01 Nov 17
Patient Specific Directions (PSDs) are often used to enable non-medical practitioners (practice nurses, health care assistants) to administer specific medicines for specific conditions.
A PSD tempate for EMIS system users has been developed by a local GP practice to improve the consistency and content of their Zoladex PSDs.
This PSD template (among others) is available from your local Medicines Management Team should your practice wish to adopt / adapt it.

Please contact your local Medicines Management Team for assistance
01 Nov 17
Patient Specific Directions (PSDs) are often used to enable non-medical practitioners (practice nurses, health care assistants) to administer specific medicines for specific conditions.
A PSD tempate for EMIS system users has been developed by a local GP practice to improve the consistency and content of their Prostap PSDs.
This PSD template (among others) is available from your local Medicines Management Team should your practice wish to adopt / adapt it.

Please contact your local Medicines Management Team for assistance
01 Nov 17
Patient Specific Directions (PSDs) are often used to enable non-medical practitioners (practice nurses, health care assistants) to administer specific medicines for specific conditions.
A PSD tempate for EMIS system users has been developed by a local GP practice to improve the consistency and content of their testosterone injection (Nebido) PSDs.
This PSD template (among others) is available from your local Medicines Management Team should your practice wish to adopt / adapt it.

Please contact your local Medicines Management Team for assistance
06 Sep 17
The MCG endorsed the following updates to the Specials advice on the PAD:

PrescQIPP Specials Optimisation Tool (SPOT) - Sep 2016 has been locally adopted and replaces the previous version.

The Royal Pharmaceutical Society guidelines and professional standards for prescribing, procurement and supply of specials - both provided below

Some common unlicensed medicines have been included within Part VIIIB of the Drug Tariff. Prices and formulations vary so prescribers should check the Tariff for the latest information and the most cost-effective way of prescribing. A link to the Drug Tariff is provided at the bottom of the page.

Information and local recommendations in relation to a number of specific unlicensed medicines can be found by searching the PAD by drug name.
02 Aug 17
The Surrey MCG agreed the local use of PrescQIPP inhaler video guides and patient information leaflets to support the improvement of patient inhaler technique
05 Apr 17
In April 2017 the MCG issued a statement in relation to vaccinations that are not approved for routine use on the NHS for TRAVEL purposes.

Hep B, combined Hep A&B and Men ACWY were of specific mention and are not locally recommended for travel

This statement is available below and is supported by a briefing issued by PrescQIPP.

07 Sep 16
EPS outage has an impact on general practice and community pharmacy. The EPS Business Continuity Plan (below) provides some practical advice in planning for, and managing an EPS outage.
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below.
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below.
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
01 Jun 16
Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”.
The cards are available for practices to order through usual NHS stationery supply routes.
See an example of the Anticoagulant Alert Card in the document below
04 Nov 15

UKMI Q&A for branded prescribing recommendations states that fentanyl patches are available as matrix and reservoir formulations; Patient familiarity with one brand is important. Generic prescribing is therefore not recommended and is considerably more costly. Matrifen (matrix) was agreed as a cost effective brand for primary care prescribing and is currently the most commonly prescribed brand of fentanyl patch amongst the Surrey CCGs. Mezolar matrix patches and Mylafent patches are similarly lower cost. Note: patches must not be cut because damage to the rate-limiting membrane can lead to a rapid release of fentanyl resulting in overdose. If the prescriber intends the patch to be cut (NB: unlicensed and not recommended by the MHRA) then the prescription must specify a brand of matrix formulation patch.

02 Sep 15

It is recommended that slow-release and longer-acting diltiazem products are prescribed by brand.

Following consideration of product price and current prescribing levels, the following were agreed as cost-effective preferred diltiazem brands for primary care:

  • Twice daily – Angitil SR capsules (available in all three strengths)
  • OR Tildiem Retard for patients preferring a tablet (although not available as 180mg strength)
  • Once daily – Zemtard XL
02 Sep 15

It is recommended that slow-release and longer-acting diltiazem products are prescribed by brand.

Following consideration of product price and current prescribing levels, the following were agreed as cost-effective preferred diltiazem brands for primary care:

  • Twice daily – Angitil SR capsules (available in all three strengths)
  • OR Tildiem Retard for patients preferring a tablet (although not available as 180mg strength)
  • Once daily – Zemtard XL 
06 May 15
Specialist Pharmacy Services have produced guidance aimed at reducing medicinal waste. The MCG considered this to be a useful resource - see below
04 Mar 15
An updated Guideline for "Crushing Medicines and the Use of Specials" was presented to, and agreed for use by, the Surrey Medicines Commissioning Group.
See document below
03 Dec 14
GPs are NOT contracted to prescribe for home births. Any drugs required for intrapartum care are the responsibility of the provider of the service.
22 Feb 12
Linezolid is considered a red drug for complicated skin and soft tissue infections - refer back to Acute Trust
22 Feb 12
Committee were asked to consider the issues associated with the prescribing of linezolid in primary care for mild to moderate skin/soft tissue infections (SSTIs) in patients: Linezolid prescribing for mild to moderate SSTI in line with HPA recommendations is an option for primary care prescribing especially where referral/admission to secondary care is to be avoided. Primary/secondary care interface: Treatment courses that are initiated in secondary care should be supplied by the Trust in their entirety. GPs should not be asked to prescribe the remainder of linezolid courses. Shared care is therefore not considered appropriate for this drug. Information sheet [linezolid]to support GPs to be developed.
22 Feb 12
Linezolid is considered a red drug for the treatment of pneumonia - refer back to Acute Trust
25 Sep 09
Zoledronic acid (Aclasta) - To use only on the recommendation of a Consultant Rheumatologist or Geriatrician in patients with osteoporosis for whom a bisphosphonate is the most appropriate line of treatment and who are unsuitable for or unable to tolerate oral bisphosphonates for osteoporosis or who are unable to comply with them and for patients with fractures despite oral bisphosphonates. It should be administered only in a place with the required clinical governance systems in place (training of staff, IV administration protocols etc).
20 May 09
The committee confirmed that rivaroxaban should be considered a hospital only RED drug for the prevention of venous thromboembolism after total hip or total knee replacement in adults - the full treatment course should be given by the acute trust provider
20 May 09
Following the presentation of further information since the last meeting the committee agreed with the use of Nebido in line with the SMC recommendation and agreed that it should be made available as an option for the treatment of male hypogonadism in Surrey PCT when testosterone deficiency has been confirmed by clinical features and biochemical tests
19 Nov 08
Local acute Trusts requested that ursodeoxycholic acid, used in the treatment of gall stones, is changed from Amber* to green. It was agreed that it should remain Amber* as initiation would still need to be carried out by the hospital

Prescribe generically.

Note - the branded product Ursofalk 250mg capsules were considered BLACK at the May 2017 PCN
26 Sep 07
September 2007 – The DH changed the regulations and advice relating to the treatment of TB. Patients requiring TB medication should be treated in specialist TB clinics where they will not be subject to prescription charges. FP10 prescriptions are not exempt from charges and should not be used.